What equipment does a phlebotomist use

Know the Risks Before Adding Phlebotomy to Your Dental Practice


The percent of common practice still providing intravenous (iv) sedation services remains low. However, the increase in blood-derived products for hard- and tissue-reforming treatment has increased the number of general dentists and specialists who draw patient blood during treatment.


Most dentists don't think drawing blood can place them on the wrong side of a malpractice lawsuit and they end up in the witness chair hopelessly trying to defend themselves. Although blood drawing is a common medical procedure, dentists may be exposed to not getting training in it at the undergraduate level and only it in the graduate seats or through continuing education.

The Risks of Drawing Blood

However, there is limited information regarding the documented complications of venipuncture. Most common of these complications have to do with injuries leading to paresthesia and forearm pain after phlebotomy to the venipuncture area because of antebrachial cutaneous nerve center damage.

AS may occur with administration of local anesthetic intraorally to achieve an inferior alveolar nerve (IAN) block where the IAN may be injured, injuries to the antebrachial cutaneous central nerve are relatively rare but are potentially a serious complication of the drawing Blood from the arm. Nerve damage from an improperly administered blood draw can result in a condition known as claw hand.

Also known as ulnar claw, or the spinster's claw, claw hand is an abnormal hand position that is developing because of a problem with the ulnar nerve. One hand in the ulnar grasper position has the fourth and fifth fingers elongated at the metacarpophalangeal joints and flexed at the interphalangeal joints. Patients with this condition can make a full fist, but when they extend their fingers the palm is referred to as a claw hand. The ring and little finger usually cannot fully extend at the proximal interphalangeal (PIP) joint.

This can become a debilitating injury and, if left untreated, can result in loss of the ability to use the arm. A New York Times reporter had this complication in 2006, writing about how a routine blood draw led to her developing claw hand and how it needed to be managed.

The lack of training

According to the Washington Post, unlike other medical skills, in many states phlebotomy does not require specialized training and largely goes uncontrolled. Many medical personnel performing phlebotomy procedures have received little training, lines leading to improper administration of blood and injuries to patients. Even a skilled phlebotomist can sometimes have problem finding or locating a vein.

The Clinical & Laboratory Standards Institute constitutes the body of knowledge on the subject from which the standard of care can be derived. Unfortunately, dentists don't know the standard of care for phlebotomy. Dental schools don't train dentists in how to draw blood, and most dentists don't invest in educating themselves.

Are recognized and effective methods to prevent nerve injury by appreciating the details and anatomical features of the peripheral arteries, nerves and veins of the arm. The recommended order of wire selection must also be followed. To prevent the needle from being inserted too deeply, shorter needles are used.

Examination is a very dangerous procedure that must be avoided, but redirection of the needle is acceptable if performed once per venipuncture. It is also critical to ask patients prior to venipuncture if they have experienced a previous nerve injury or other conditions such as a mastectomy that require modified techniques.

Figure 2: Hematoma resulting from trauma to the blood vessel during blood drawing shown several days following phlebotomy.

A phlebotomist may miss the vein and instead puncture a nearby nerve, causing shooting pain or paralyzing damage to the affected arm. Other types of injury may occur when the needle fully guides the vein and punctures an artery or squeezes the vein, which can cause significant internal bleeding and result in a hematoma (Figures 1 and 2). Phlebotomy patients are not injured directly from the needle itself, but they faint and consciousness as a result of anxiety related to the overall experience and potentially injure in the resulting event.

Protect against liability

The risk of nerve injury can never be completely eliminated. But when an injury occurs, the determination of liability for the injury remnants was made on the plaintiff's attorney trying to find flaws in the way the procedure is carried out, and the professional medical training is evaluating.

The biggest factor in avoiding phlebotomy complications is getting proper hands-on training in these procedures. Additionally, knowing the anatomy of the arm and how to manage complications they arise can aid in limiting liability for those dental practitioners who draw blood from their patients.

The nerves leading the antecubital area may not be visible or obvious. It is crucial that those performing venipunctures know the anatomy of the antecubital fossa. Medical professionals performing venipunctures especially need to know where the nerves and arteries lie in relation to the acceptable veins for venipuncture in that area.

Dentists and specialists who routinely perform venous punctures should receive some type of certification or training from a valid source. This gives them more confidence in their routine venipuncture procedure and they have a better sample every time. It also helps to keep them and their patients unnecessarily safe from complications and litigation.

Dr. Javid received his Doctorate in Dental Surgery from the Dental School at the University of Southern California (USC) and is a former member of the USC Graduate School in General Dentistry faculty. He is also a diplomat of the International Congress of Oral Implantology, Fellow of the California Implant Institute, Associate Fellow of the World Congress Laser Institute, Clinical Phlobotomy Technician, Member of the Biolase Advisory Board, DIO Implant Medical Director , a researcher DIO Navi, CEO of the Doctor Smile Dental Group, CEO of the Southbay Implants Institute and a member of the Children's Community Board. Its practice is limited to implant dentistry, full mouth reconstruction, and laser dentistry. He can be reached at [email protected]

Dr. Kurtzman is in private public practice in Silver Spring, Md and is a former assistant clinical professor at the University of Maryland, Department of Endodontics, Prosthetics and Operational Dentistry. He has earned scholarships in the AGD, American College of Dentists, International Congress of Oral Implantologists (ICOI), Pierre Fauchard Academy, and the Academy of Dentistry International as well as a championship in AGD and the ICOI and a diplomatic status in the ICOI and American in dental implants -Academy. He has lectured internationally and published more than 585 articles. He can be reached at [email protected]